Provider Demographics
NPI:1376759720
Name:BUXTON FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:BUXTON FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-892-7770
Mailing Address - Street 1:3059 EDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3225
Mailing Address - Country:US
Mailing Address - Phone:718-892-7770
Mailing Address - Fax:178-897-7771
Practice Address - Street 1:1250 WATERS PL STE 507
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2732
Practice Address - Country:US
Practice Address - Phone:718-892-7770
Practice Address - Fax:178-897-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219669261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2119400Medicaid
NY2119400Medicaid